Ah, The Mediterranean

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If you are a reader of this column, then you know that I have written previously about the healthy effects of the Mediterranean diet. This diet, initially thought to be a fad diet when first introduced in the 1970s, is a healthy way to live and eat, especially when combined with moderate exercise and weight control. The main staple of the diet is olive oil, although most people who live in the Mediterranean basin use olive oil on salads and cook with lard and butter. The other ingredients of the diet include legumes (alfalfa, beans, peas, chickpeas, lentils, soybeans, and peanuts), unrefined cereals (aka whole grains), fresh fruits, vegetables (including green leafy ones), fish, dairy (mostly cheese and yogurt), and red wine. There are very little non-fish meats, processed meats (hot dogs, sausage, bologna), eggs, and sweets in the diet. There is a paradox regarding those who live in the Mediterranean basin, akin to the French paradox. The paradox is that even though their diet is high in fat (and wine for the French), the rates of cardiovascular disease are much lower than most other western countries, including the U.S.

The disease burden from obesity has increased rapidly during the past three decades in close association with excess caloric intake and poor nutritional quality. Evaluations of lifestyle interventions to decrease obesity are among the top priorities in public health. Good adherence to the Mediterranean diet has been associated with reduced all-cause mortality, nonfatal cardiovascular disease, Type 2 diabetes and its long-term complications, and overweight/obesity. Studies have also shown reduced rates of metabolic syndrome, which is a combination of diabetes, elevated cholesterol, and hypertension. Not long ago, the results of a clinical study done in Spain, called the PREDIMED-Plus trial, were published. This study took the Mediterranean diet a step further. They looked at the effects of an energy-reduced Mediterranean diet vs. a standard Mediterranean diet. The control group ate the traditional Mediterranean diet, while the study group ate the energy-reduced one, which consisted of more restrictive limits on red and processed meats, butter, margarine and cream, and carbonated sweetened beverages. In addition, the study group did not add sugar to beverages and limited consumption of white bread and refined cereals, while they increased their consumption of whole grains. The study group also had more dietary counseling sessions and physical activity. Both groups were provided with one liter per month of extra-virgin olive oil, 125 grams per month of almonds, and 500 grams per month of mixed nuts.

Not surprisingly, the study group had much better adherence to the diet than the control group, plus better diet quality, energy intake, and lower cardiovascular disease risk. The study group also lost more weight and had a more reduced waist size than the control group. While these are just the preliminary results, it is anticipated that the study group will have even more reductions in diabetes and heart disease, as well as mortality rate, over time. If you haven’t already done so, look up the Mediterranean diet. After all, any diet that includes wine can’t be all that bad.

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 By Peter Galvin, MD

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